Developing Evidence-Based Pathways to Sustained Recovery
On the 22nd and the 23rd of July we held a two-day training event for around 45 peer navigators and Certified Recovery Residence Administrators (CRRAs) hailing not only from Florida but from across the country, with the training event led by Professor David Best and George Braucht.
The training focused on the four main areas that are at the heart of the REC-CAP model. These four stages will be discussed in some detail in this article:
- Completing and scoring the REC-CAP measure
- Building a shared recovery care plan based on the score profile of the REC-CAP
- Working with the client to implement actions items emerging from REC-CAP care planning that involve building social and community recovery capital
- Building a Community of Practice through the Advanced Recovery Management System (ARMS) to support a sustainable partnership between academics and practitioners moving forward to ensure the best possible model for participating residents.
Within these four stages are seven distinct steps that guide progression through the REC-CAP model.
As a project team, work remains in each of these areas, but what we seek to accomplish in this article is outline the logic and rationale for each stage and describe steps we are currently taking to make this model work for navigators and clients:
Stage 1: Completing and scoring the REC-CAP measure
Step 1: Completing the REC-CAP
Why? The REC-CAP is a way of measuring barriers to recovery, ongoing service needs of your clients and then crucially identifying strengths that they possess to support them in their recovery journeys. The REC-CAP is an instrument that can chart not only where a client currently is but can also chart the trajectory of their recovery journey, and the unique pathway to growing recovery capital and sustainable change.
The scale was first tested and implemented with eight recovery residences in Florida resulting in more than 500 successful completions, from which we have been able to establish a clear pathway to how recovery grows, and that the measure effectively engages both peer navigators and residents in a shared measurement process.
The key to fostering wellbeing in residents of FARR Certified Programs is that they are retained long enough to grow recovery capital. But that, in and of itself, is not enough. Residents also benefit from engaging in meaningful activities. When they do this, they both grow personal and social recovery capital and improve overall wellbeing. So; we have begun to understand how the recovery residences promote wellbeing. The next phase for the science is for us to look at people who have completed more than one REC-CAP assessment and chart the growth of recovery capital over time – showing not only what works in recovery residences but also for whom. We now have sufficient data commence analysis that predicts who will do well and under what circumstances.
One significant enhancement that we are currently implementing is transitioning from the paper and pencil format, that we employed during the initial pilot, to an online platform where clients and peer navigators can complete the REC CAP Assessment directly on a laptop, tablet or smart phone.
Step 2: Scoring the REC-CAP
Why is this important? It is not only much more portable but crucially it moves us forward as it allows us to automatically code and score client responses. This empowers us to provide clients and navigators with a profile of scores instantly – in other words, as soon as the assessment is completed, both stakeholders are provided with a visualisation of the results immediately. No delay between completing assessment and visualizing the score profile informs the process of effective and evidence-based recovery care planning. And this should facilitates the second step which is how to interpret the profile generated by REC-CAP Assessment and begin utilizing that information to mentor the client to devise a self-directed recovery care plan.
Stage 2: Node-link mapping and recovery care planning
Step 3: Node-link mapping
What we have done that is different from previous measures of recovery capital is to link this directly to recovery care planning so that the score profile of strengths, barriers and needs can be used to populate an overview visualisation map of where the resident is in their recovery journey. What we are currently working on is a way of showing how that has changed at each of the reviews from the previous completion so that we can support positive change and growth over time.
Node-link mapping is a visualisation technique, developed in the addictions field by the Institute of Behavioral Research at Texas Christian University, that has been shown to improve communication, help to build therapeutic relationships, improve recall of sessions and effectively engage the client in the session. What we are asking peer navigators to do is to use the node link maps at the back of each manual to help shape a recovery care plan specifically tailored for individual residents.
Step 4: Recovery care planning
The product of node-link mapping is a set of aims and goals upon which both the navigator and the resident reach consensus. These aims fulfil the principles of SMART (Specific, Measurable, Achievable, Realistic and Time-limited) and are positively framed to ensure residents build on their successes.
The other core principle of goal-setting is that they are individual and personal and utilise the recovery strengths the person already possesses. This strengths-based approach requires skilled support on the part of the peer navigator, whose role it is to both support the selection of the goal and the identification of appropriate steps towards achieving it, and who also will have a role in mentoring the achievement of these goals. Given what we know about sustainable recovery, these goals will generally be directed towards meaningful activities (including but not restricted to work) and engaging with positive and prosocial groups who can offer positive social capital.
Stage 3: Supporting achievement of the goals set (assertive linkage and community engagement)
There are two primary objectives for the peer navigator to support residents to achieve their goals around effective community integration:
Step 5: Identifying appropriate community assets
Step 6: Acting as a community connector to support the person to engage with the groups and benefit from them
A major aim of the ARMS system (the online platform for delivering and coordinating the REC-CAP monitoring and mapping process) is to identify an appropriate range of community assets that residents can be linked into, primarily in four areas:
- Employment, training and education
- Sports, recreation and the arts
- Community engagement and volunteering
- Mutual aid and other recovery support groups
The general evidence around recovery is that belonging to multiple groups is beneficial and protective in that it creates multiple types of support and access to a diverse range of community-based supports and resources. Additionally, it offers positive social identities and helps to foster a sense of belonging and empowerment in the local community.
All communities, even the most impoverished, possess assets and resources that are available to some people and the challenge for service providers and recovery residences is to effectively tap into them; this is the purpose of Step 5. One of the most exciting things about the ARMS solution is that we will record and map those resources that navigators and clients access to help create a directory available to all providers and recovery residences utilizing the ARMS program.
However, simply knowing that there are available resources falls short of achieving the objective. The second half of this phase surrounds effective linkage into identified groups. This is where the peer navigator must either assume the role of, or link his or her residents to, community connectors who will support their engagement with the community group or activity. The research is abundantly clear that giving residents early in recovery a telephone number or a leaflet is highly unlikely to result in an effective engagement. Thus, Step 6 is around active community connection through which trusted and recognized individuals support the process of engagement. This is the role of the community connector.
Stage 4: Being a part of the ARMS team
Step 7: Developing a Community of Practice
Our final objective is to create what is known as a Community of Practice (CoP) to support the implementation of each of the above steps. For a peer recovery model like this, it is critical we achieve engagement and feedback from those who actually deliver the model and who are therefore well-positioned to share with us what works and what requires modification. We have translated a much research evidence and practical experience into the development of each stage of our model and, no doubt, we will learn a great deal from service delivery. For that reason, we are recruiting a team of expert navigators to share lessons gained through experience and who support their peers through a supervisory and communication platform. The aim of this approach is to create a channel through which we can receive feedback and that navigators support each other to make the most of the ARMS system and help development staff to continuously improve and refine it. Thus, Step 7 is the development of a group of navigators from across a range of service providers and recovery residences who work with each other and work with us to help implement the model as smoothly as possible and to ensure that we can continue to innovate and grow through your experiences and ideas.
So, in conclusion, these are the seven steps that support residents in their recovery pathways and our plan to enhance the REC-CAP model as it continues to empower effective recovery growth. We have had a tremendous first year and we are ask those of you who have chosen to participate in our effort to be a part of the team that will continue to help support your residents’ recovery and to enhance the science of recovery for a much larger group of people attempting to overcome addictive behaviours.